Coronary Artery Disease: Management and drugs high cholesterol Flashcards
Cholesterol. What are the two types of cholesterol carriers?
Low-density-Lipoprotein (LDL) and High-Density-Lipoprotein (HDL)
Why is LDL related to coronary artery disease?
LDL cholesterol is susceptibe to oxidation at damaged endothelium, and it builds up in arteries, promoting atherosclerosis
WHy is HDL related to coronary artery disease?
HDL also known as the good cholesterol carries cholesterol from the circulation, to the liver for recycling. This reduced the chance of cholesterol build up in the arteries therefore less chance of atherosclesrosis.
What is Cholesterol screening?
This is part of the CVD screening and is used to predict the 10 year CVD risk.
A capillary pin prik test shows the total lipoproteins, and HDL non-fasting.
Venous test will show the total, HDL, non-HDL and triglycerides.
If total HDL-C >6mmol/L, then at HIGH risk of atherosclerosis.
Primary Prevention: What are the steps in this?
1) Identify the high risk patients
2) Modify lifestyle and any risk factors present
3) May need to make the decision of initiating a pharmacological therapy.
Primary prevention is for people at risk of developing CVD
What are considered when thinking of pharmacological primary prevention?
decision of initiating a pharmacological therapy based on:
1) Polypharmacy
2) Baseline Profile
3) Possible lifestyle benefits
Other things that must be considered are Renal and Liver function
TSH, BP, BMI< smoking, alcohol.
What is secondary preveniton?
This is for people with established CVD, that are started with Statin treatment to manage MODIFIABLE RISK FACTORS.
How do statins work?
They lower LDL cholesterol levels in the blood by inhibiting the HMG-CoA reductase enzyme in the Mevalonate Pathway in the production of Cholesterol
WHat are the overall benefits and aims of statins?
1) Improve endothelial function which will aid in the reduction of atherosclerotic plaques forming
2) Modulate Inflammatory response
3) Maintain the stability of any plaques already present to reduce the chance of rupture
4) Prevent thrombus formation
5) Reduce LDL-cholesterol
WHat are the examples?
Atorvastatin, Simvastatin, Pravastatin.
Primary prevention Drug Guidelines:
1) Atorvastatin Once Daily if the CVD 10 year risk is >10% using QRISK.
The aim is t reduce LDL-C by >40% in 3 months.
Secondary prevention Drug Guidelines:
80mg Atorvastatin od for life for established CVD or post acute myocardial infarction.
What are the side effects of statins?
Pain, tenderness, muscle weakness
What must be measured while on Statins?
Creatinine levels need to be measured
What should be avoided while on Statins?
Grape Fruit juice as it increases first pass metabolism increasing the amount of drug absorbed from the intestine into the liver, then increasing levels in plasma.
